@article{ref1,
title="Clinical outcomes and history of fall in patients with atrial fibrillation treated with oral anticoagulation: insights from the ARISTOTLE Trial",
journal="American journal of medicine",
year="2018",
author="Rao, Meena P. and Vinereanu, Dragos and Wojdyla, Daniel M. and Alexander, John H. and Atar, Dan and Hylek, Elaine M. and Hanna, Michael and Wallentin, Lars and Lopes, Renato D. and Gersh, Bernard J. and Granger, Christopher B.",
volume="131",
number="3",
pages="269-275.e2",
abstract="PURPOSE: We assessed outcomes among anticoagulated patients with atrial fibrillation (AF) and a history of falling, and whether the benefits of apixaban versus warfarin are consistent in this population. <br><br>METHODS: Of the 18,201 patients in ARISTOTLE, 16,491 had information about history of falling - 753 with history of falling and 15,738 without history of falling. The primary efficacy outcome was stroke or systemic embolism; the primary safety outcome was major bleeding. <br><br>RESULTS: When compared with patients without a history of falling, patients with a history of falling were older, more likely to be female and have dementia, cerebrovascular disease, depression, diabetes, heart failure, osteoporosis, fractures, and higher CHA2DS2-VASc and HAS-BLED scores. Patients with a history of falling had higher rates of major bleeding (adjusted HR 1.39; 95% CI 1.05-1.84; p=0.020), including intracranial bleeding (adjusted HR 1.87, 95% CI 1.02-3.43; p=0.044), and death (adjusted HR 1.70; 95% CI 1.36-2.14; p<0.0001), but similar rates of stroke or systemic embolism and hemorrhagic stroke. There was no evidence of a differential effect of apixaban compared with warfarin on any outcome, regardless of history of falling. Among those with a history of falling, subdural bleeding occurred in 5 of 367 patients treated with warfarin and 0 of 386 treated with apixaban. <br><br>CONCLUSIONS: Patients with AF and a history of falling receiving anticoagulation have a higher risk of major bleeding, including intracranial, and death. The efficacy and safety of apixaban compared with warfarin were consistent, irrespective of history of falling.<br><br>Copyright © 2017. Published by Elsevier Inc.<p /> <p>Language: en</p>",
language="en",
issn="0002-9343",
doi="10.1016/j.amjmed.2017.10.036",
url="http://dx.doi.org/10.1016/j.amjmed.2017.10.036"
}